Survival and Functional Status Outcomes in Heart Transplant Recipients: An Analysis of Organs From Donors Who Overdosed.

INTRODUCTION

Escalating deaths associated with the opioid crisis has increased availability of transplant organs from donors who died of a drug overdose, yet perception of these organs as "increased risk" contributes to their unnecessary discard. Previous research addressing this issue has focused solely on survival outcomes, but quality of life is also a crucial factor in determining transplant success.

METHODS

In this study, a secondary analysis of data representing adult, first-time heart transplant recipients from the Scientific Registry of Transplant Recipients between January 1, 2016, and March 1, 2020 was conducted. Logistic regression modeled one-year survival and functional status at one-year, and Cox proportional hazards modeled survival time post-transplant. Non-inferiority testing compared survival and functional status outcomes for overdose donor (n = 2240) and non-overdose donor (n = 9427) organ recipients.

RESULTS

When not controlling for significant covariates, one-year survival rates, post-transplant survival time, and one-year Karnofsky scores were at least as good or better for overdose donor organ recipients compared to non-overdose organ recipients based on a-priori non-inferiority thresholds; estimated OR for one-year survival is 1.0207 (95% CI [0.863, 1.213]), estimated hazards ratio is 0.9425 (95% CI [0.823, 1.079]), and estimated OR for having high one-year functional status is 0.9035 (95% CI [0.769, 1.066]). Controlling for significant covariates, one-year survival (OR 0.9613, 95% CI [0.790, 1.176]) and functional status (OR 1.0181, 95% CI [0.855, 1.218]) remained at least as good or better for overdose donor recipients; survival time was also estimated to be as good or better for overdose organ recipients when controlling for significant covariates (HR 0.9611, 95% CI [0.828, 1.115]), but not to the level of statistical significance based on the non-inferiority threshold.

CONCLUSION

Overall, post-transplant survival times, one-year survival rates, and one-year functional status are similar for overdose and non-overdose organ heart transplant recipients. These findings support a broader utilization of the drug overdose donor pool, especially as the demand for heart transplantation increases.